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Indian Health Service The Federal Health Program for American Indians and Alaska Natives


     Indian Health Manual
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Part 3, Chapter 17:  Manual Exhibit 3-17-D

Emergency Medical Services
Program Review Evaluation Checklist


The Indian Health Service (IHS) Emergency Medical Services (EMS) Program performs periodic reviews of EMS systems within IHS, and is available to perform reviews on tribally-operated EMS programs, a their request.  In addition, each Area, Service Unit, and tribal health entity is encouraged to evaluate its own EMS programs utilizing the checklist below.

Checklists used during a program review should be selected and modified to be appropriate for the EMS system being reviewed.

Items in CAPITAL LETTERS should be considered mandatory, while the others are recommended goals in developing the best quality EMS programs.

  1. PERSONNEL AND TRAINING.

    1. Standard:  Ambulance Service Director (or equivalent) is certified and experienced in EMS.

    2. Status:
    3. Standard:  MEDICAL DIRECTOR IS A PHYSICIAN APPROVED BY THE SERVICE UNIT AND/OR TRIBAL UNIT AUTHORITY.

    4. Status:
    5. Standard:  MEDICAL DIRECTOR HAS COMPLETED EMS MEDICAL DIRECTOR TRAINING COURSE.

    6. Status:
    7. Standard:  THERE IS SUFFICIENT NUMBER OF CERTIFIED BASIC EMTs.

    8. Status:
    9. Standard:  Basic EMTs individual skills are approved by the EMS Medical Director.

    10. Status:
    11. Standard:  THERE IS A SUFFICIENT NUMBER OF CERTIFIED ADVANCED EMTs (INTERMEDIATE AND/OR PARAMEDIC).

    12. Status:
    13. Standard:  ADVANCED EMTs INDIVIDUAL SKILLS ARE APPROVED BY THE EMS MEDICAL DIRECTOR.

    14. Status:
    15. Standard:  There is a sufficient number of certified dispatchers.

    16. Status:
    17. Standard:  There is a sufficient number of support personnel (clerks, etc. )

    18. Status:
    19. Standard:  All patient care personnel obtain the appropriate amount of annual continuing education.

    20. Status:

  2. POLICY AND OVERSIGHT.

    1. Standard:  The following clinical policies and protocols are available and have been approved by the EMS Medical Director:

      1. HANDLING OF INCOMING EMERGENCY CALLS.

      2. Level of response (ALS/BLS) for each type of emergency.

      3. PROTOCOLS/STANDING ORDERS FOR FIELD EVALUATION AND TREATMENT.

      4. CRITERIA FOR TRANSPORTATION:  METHOD AND PROPER DESTINATION.

      5. Protocols for emergency communication between ambulance and base station.

      6. Base station agreements.

      7. MUTUAL AID AGREEMENTS WITH ADJACENT EMS PROGRAMS.

      8. Status:

    2. Standard:  THE EMS MEDICAL DIRECTOR HAS FORMAL INVOLVEMENT IN:

      1. DESIGN AND ONGOING REVISION OF THE EMS SYSTEM.

      2. TRAINING, CERTIFICATION, AND CONTINUING EDUCATION OF EMTs (ADVANCED AND BASIC) AND DISPATCHERS.

      3. OPERATION OF THE EMS SYSTEM.

      4. EVALUATION AND IMPROVEMENT OF THE EMS SYSTEM.

      5. Status:

    3. Communications and Emergency Response:

    4. Standard:  INCOMING EMERGENCY CALLS ARE HANDLED EFFICIENTLY.

    5. Status:

    6. Standard:  ACCESS TO EMERGENCY MEDICAL SERVICES IS PROVIDED TO ALL CALLERS WITHOUT REGARD TO THE PATIENT'S RACE, SEX, TRIBAL AFFILIATION, OR ABILITY TO PAY.

    7. Status:

    8. Standard:  Emergency access is through a universal "911" telephone number.

    9. Status:

    10. Standard:  Dispatch is centralized and performed by certified Emergency Medical Dispatchers.

    11. Status:

    12. Standard:  Dispatchers use pre-arrival instructions to guide emergency callers.

    13. Status:

    14. Standard:  TRAINED FIRST RESPONDERS ARE AVAILABLE TO RESPOND TO ALL COMMUNITIES WITHIN 15 MINUTES.

    15. Status:

    16. Standard:  TRANSPORTATION BY CERTIFIED EMTs (ADVANCED OR BASIC) IS AVAILABLE TO RESPOND TO ALL COMMUNITIES WITHIN 60 MINUTES.

    17. Status:

    18. Standard:  TWO CERTIFIED EMTs STAFF EACH AMBULANCE RESPONDING TO AN EMERGENCY.

    19. Status:

    20. Standard:  Ambulance communications equipment allows communications with the dispatcher during emergency responses.

    21. Status:

    22. Standard:  AMBULANCES HAVE FUNCTIONING COMMUNICATIONS EQUIPMENT WHICH ALLOWS COMMUNICATIONS WITH THE HOSPITAL OR BASE STATION FROM ALL POINTS IN THE GEOGRAPHICAL RESPONSE AREA.

    23. Status:

    24. Standard:  ON-LINE MEDICAL DIRECTION (MEDICAL CONTROL) IS PERFORMED BY A LICENSED PHYSICIAN WITH SPECIFIC PRIVILEGES TO PROVIDE ON-LINE MEDICAL DIRECTION.

    25. Status:

    26. Standard:  There is regular communication between the ambulance and the on-line medical control.

    27. Status:

    28. Standard:  The system includes communications equipment which allows communications with public safety officers during emergencies.

    29. Status:

  3. EQUIPMENT.

    1. Standard:  AMBULANCE VEHICLES MEET FEDERAL SPECIFICATIONS FOR AMBULANCES.

    2. Status:

    3. Standard:  AMBULANCE SUPPLIES AND EQUIPMENT MEET FEDERAL OR STATE SPECIFICATIONS.

    4. Status:

    5. Standard:  There is a sufficient supply of appropriate extrication equipment.

    6. Status:

  4. RECORDS

    1. Standard:  A RUN SHEET (PATIENT CARE RECORD) IS COMPLETED ON EACH EMERGENCY RUN.

    2. Status:

    3. Standard:  THE RUN SHEET BECOMES PART OF THE MEDICAL RECORD AT THE RECEIVING FACILITY.

    4. Status:

    5. Standard:  Logs of communications and emergency runs are maintained.

    6. Status:

  5. EVALUATION.

    1. Standard:  THE EMS PROGRAM COLLECTS AND ANALYZES DATA ON INDICATORS TO MONITOR THE QUALITY OF CARE.

    2. Status:

    3. Standard:  AMBULANCE RUN SHEETS ARE REVIEWED REGULARLY (MONTHLY) BY THE MEDICAL DIRECTOR.

    4. Status:

    5. Standard:  IN ALS SERVICES, THE PERFORMANCE OF SELECTED ADVANCED FIELD PROCEDURES BY ADVANCED EMTs IS REGULARLY REVIEWED BY THE MEDICAL DIRECTOR.

    6. Status:

    7. Standard:  THERE ARE PROVISIONS FOR INPUT FROM THE PATIENTS, TRIBE AND/OR COMMUNITY.

    8. Status:

    9. Standard:  THE EMS MEDICAL DIRECTOR HAS AUTHORITY TO SUSPEND CLINICAL DUTIES OF EMS PERSONNEL WHEN WARRANTED FOR PATIENT SAFETY.

    10. Status:

    11. Standard:  Results of quality monitoring activities are reported to Service Unit/or tribal authorities responsible for the EMS program.

    12. Status:

    13. Standard:  The program undergoes National IHS Program Review every four years.

    14. Status:


  6. COMMUNITY PARTICIPATION.

    1. Standard:  THE MEANS OF REACHING EMS IN AN EMERGENCY ARE WIDELY PUBLICIZED IN THE COMMUNITY.

    2. Status:

    3. Standard  COMMUNITY MEMBERS EXPECTED TO RESPOND TO MEDICAL EMERGENCIES HAVE COMPLETED TRAINING IN FIRST AID, FIRST RESPONDER, OR OTHER APPROPRIATE TRAINING FOR MEDICAL EMERGENCIES.

    4. Status:

    5. Standard:  THERE IS AN ACTIVE COMMUNITY CPR TRAINING PROGRAM.

    6. Status:

    7. Standard:  THE EMS PROGRAM PARTICIPATES IN SAFETY/INJURY PREVENTION PROGRAMS AND SUBSTANCE ABUSE CONTROL PROGRAMS.

    8. Status:

    9. Standard:  The program participates in a community council or other public forum in which EMS issues are addressed.

    10. Status:

    11. Standard:  The program participates in a state, regional or national Trauma Registry.

    12. Status:

    13. Standard:  DISASTER PLANS ARE IN PLACE WHICH ARE COORDINATED WITH COMMUNITY ORGANIZATIONS.

    14. Status:



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